Some Blue Cross & Blue Shield of Mississippi members could pay 29 times more for the same procedure at Jackson-based University of Mississippi Medical Center if the provider leaves the insurer's network, according to the Clarion Ledger.
A 28-year-old contract between UMMC and BCBS is set to expire July 1. A major sticking point is that UMMC's contract with BCBS allows the payer to change financial terms of the agreement without notice, according to Kevin Cook, CEO of UMMC. While BCBS argues UMMC wants to be treated differently than other area hospitals, UMMC has leveraged its status as the only academic medical center in the state, as well as the only children's hospital, as a counter-argument against the insurer.
If the companies' agreement expires without resolution, it could mean huge out-of-pocket costs for BCBS members who continue to seek treatment at UMMC for nonemergent reasons, or who are not continuing pregnancy treatment or care for a previously diagnosed illness.
For example, if a BCBS member received a colonoscopy at UMMC under the current contract, their out-of-pocket cost would be $177. That bill would soar to $5,135 if UMMC exits BCBS' network, 29 times the in-network cost, according to data the Mississippi Insurance Department provided the Clarion Ledger.
In another instance, if a BCBS member received an MRI of the spine at UMMC under the current contract, their out-of-pocket cost would be $171, compared to the out-of-network cost of $1,752. This assumes the patient would owe a 20 percent copayment and has already met his or her deductible, and excludes physician charges and other professional expenses.
The numbers shed light on the vast differences between hospitals' in-network rates with payers compared to out-of-network rates.
State Insurance Commissioner Mike Chaney commented on the situation June 27: "As commissioner of insurance, I am very limited in my ability to get involved with contract disputes. However, both UMMC and BCBSMS have agreed to a mediation proposal from the MID, that should take place within the next few weeks. I remain hopeful that the parties will find common ground and settle the dispute."
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